The last six months have been surreal. After COVID-19 started spreading throughout the United States, I spent March and April rolling out protocols and training our urgent care team in combating the spread of the virus. I juggled that with examining patients who came to our clinics with acute illnesses, some of them life-threatening conditions that ultimately required hospitalization.

I thought I was an essential worker, and I was willing to risk my life to administer the care I’d spent years training to provide. But it turns out my job was also at risk. In thanks for my service, I received a furlough in April and a pink slip in June.

Getting rid of PAs as we face a pandemic is like laying off firefighters when forests are ablaze.

As a lead physician assistant for an urgent care department, I never thought my job would be dispensable during a global health disaster. Getting rid of PAs as we face a pandemic is like laying off firefighters when forests are ablaze. But I am hardly alone. As health care workers get publicly celebrated for their heroics, behind the scenes thousands are getting pushed out the door.

Nearly 1.5 million health care workers lost their jobs in a single month this spring. Some positions have begun to reopen, but far from all. That health care jobs are increasingly a casualty of COVID-19 might sound absurd and unjust, but it makes cold-hearted sense given the financial fragility — and focus — of the system. Profits are a major driver of employment decisions, even in an industry that claims to prioritize community health. When patient encounters decreased, it was health care workers who saw their pay, benefits and hours decrease, too.

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Since I was a part of the leadership team in an urgent care department, I know firsthand how we struggled to stay abreast of ever-changing COVID-19 guidelines from health authorities. As a team, we led our department through unprecedented uncertainty and managed the rising anxiety of our patients and families. We planned to work through this.

But soon, patients who had appointments for routine care and illness were rescheduled, and patient volume in outpatient care settings like mine decreased dramatically. Patients were scared, and so were health care facilities. Patients with coronavirus-like symptoms were told to go home and self-quarantine. Their other healthcare needs were temporarily shelved due to a fear of catching or spreading this novel virus, while COVID-19 tests were limited for weeks because of a lack of supplies. So, while other healthcare workers walked into their hospitals to grateful applause, I was quietly laid off.

I have 12 years of experience as a PA, mostly in emergency and urgent care facilities. But one day last month, I walked out of my office with a box full of well-worn medical textbooks and an idle stethoscope. Many others face the same fate. According to new research by the American Academy of PAs, almost nine percent of PAs nationally are furloughed right now. And PAs are not alone; many physicians, dentists and other clinicians also face this new reality.

One of the ironies of this situation is that physician assistants are taught to be flexible, quickly shift responsibilities and respond to unanticipated needs. PAs are trained as generalists and can practice in different specialties and settings as necessary. We diagnose illness, develop and manage treatment plans, prescribe medications and often serve as a patient’s principal healthcare provider. We are trained to collaborate and work as a part of a team alongside physicians and nurses.

Like all health care providers, PAs responded to the COVID-19 crisis despite the lack of adequate personal protective equipment and other resources when it first struck. They found themselves working in other departments and specialties. When still employed, I volunteered to be on a back-up list for the local emergency department, though I was never called upon.

But our versatility — perfectly suited to a time of crisis — hasn’t been enough to save many of our jobs. Instead, it often seems the health care industry’s ability to pivot PAs where we’re needed most is thwarted by burdensome laws and regulations that mean we have less opportunity under the best of circumstances, and create a domino effect when the economy bottoms out. Though some states have removed barriers, others require each PA to have a specific relationship with a physician in order to practice medicine, even though PAs have their own licenses to practice and write prescriptions.

This moment of dramatic change and need shows that these restrictions are unnecessary. Several states removed this requirement during their states of emergencies, a simple change that allowed patients to receive essential, timely care. More states should follow their lead.

That health care jobs are increasingly a casualty of COVID-19 might sound absurd and unjust, but it makes cold-hearted sense given the financial fragility — and focus — of the system.

Even when there’s not a crisis, being tied to a specific MD means that PAs can’t fill the vital need in providing care to underserved patients in urban and rural communities because by definition they lack those MDs. But now more than ever we need to increase access to care by removing PA barriers to practice so we can treat these communities, particularly communities of color that have higher rates of COVID-19 infections.

Being laid off left me feeling betrayed — not only by my department, but by the entire health care system. I have hope that as a country we can come together to support and strengthen this system. Simple, cost-effective solutions that help employ more PAs is one of them. My job shouldn’t be at risk every time a health crisis erupts. That’s when I and other PAs are needed most.


  • The secret war many doctors on the coronavirus front lines now face
  • My husband is a doctor treating patients with coronavirus. So we said goodbye for a while.
  • Covid Chronicles, Vol. 1: A nurse’s anguish in the ICU

Rachael Jarman

Rachael Jarman is a physician assistant in Minneapolis and a member of the American Academy of Physician Assistants.